10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The PEM exam has 200 questions and runs 4 hours 30 minutes.
These 10 free PEM questions are organized by exam domain, so you can see how each part of the Pediatric Emergency Medicine blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Trauma 12% of exam
Question 1
Four hours after a witnessed 60-cm fall from a sofa, a 9-month-old remains playful and feeds normally. He cried immediately, had no loss of consciousness or vomiting, and has a 2-cm frontal scalp hematoma. GCS is 15, examination reveals no palpable skull defect or other injury, and his parents report normal behavior throughout observation. He has no bleeding disorder, ventricular shunt, or safeguarding concern. His parents understand return precautions and can obtain reassessment. How should the head injury be managed now?
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Correct answer: B - Discharge with head-injury precautions and no neuroimaging.
Domain 2: Resuscitation 10% of exam
Question 2
An 8-year-old weighing 24 kg develops an abrupt, regular tachycardia at 248/min with a QRS duration of 0.06 seconds. He is confused, with a blood pressure of 66/36 mmHg and a weak but palpable pulse. Oxygenation and vascular access have been addressed. A synchronized 24-J shock fails to terminate the rhythm, and he remains hypotensive. Which setting should be selected for the next shock?
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Correct answer: D - Synchronized cardioversion at 48 J
Domain 3: Infectious Diseases 8% of exam
Question 3
A previously healthy, term 45-day-old infant has a rectal temperature of 38.3°C. She is alert, feeds normally, and has no focal findings or herpes simplex risk factors. Catheterized urine has positive nitrites, 3+ leukocyte esterase, and 45 white cells per high-power field. Procalcitonin is 0.12 ng/mL, C-reactive protein 5 mg/L, and absolute neutrophil count 2,400/µL. Blood and urine cultures are pending, with an ED follow-up service assigned to review the results. Her caregivers prefer home care, have reliable telephone access and transportation, and can return for examination within 24 hours. What is the most appropriate initial plan?
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Correct answer: A - Begin oral UTI therapy, omit lumbar puncture, and arrange reassessment within 24 hours.
Domain 4: Procedures 5% of exam
Question 4
During laceration repair, a 7-year-old who received titrated IV midazolam and fentanyl stops responding to speech or light touch. With a firm trapezius squeeze, he deliberately reaches up and pushes the examiner's hand away. Upper-airway obstruction requires a jaw thrust; blood pressure remains stable, and SpO2 is 99% on supplemental oxygen. How is his current depth of sedation classified?
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Correct answer: D - Deep sedation
Domain 7: Toxicology 4% of exam
Question 5
A 15-year-old is somnolent after an amitriptyline ingestion. Her heart rate is 138/min and blood pressure 76/40 mmHg. The ECG shows a QRS duration of 146 milliseconds. Airway support and IV access are in place. The initial medication targeted to this cardiotoxicity is:
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Correct answer: B - IV sodium bicarbonate
Domain 8: Child Abuse and Maltreatment 4% of exam
Question 6
A 3-month-old infant who cannot yet roll is brought for a single 5-mm bruise on the upper arm. The caregiver reports that an older sibling grabbed the infant there. The remainder of the examination is normal, without patterned bruising. How should TEN-4-FACESp be applied to this finding?
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Correct answer: C - The screen is positive because any bruise at this age warrants further abuse evaluation.
Domain 11: Pulmonary 8% of exam
Question 7
After two hours of continuous nebulized albuterol, a 10-year-old with asthma has good bilateral air entry, minimal wheezing, and no retractions. He is alert, afebrile, and well perfused, with SpO2 98% on room air, but his respiratory rate has increased to 44/min. Venous testing shows pH 7.31, PCO2 29 mmHg, bicarbonate 14 mmol/L, and lactate 6.5 mmol/L; lactate was 1.2 mmol/L before treatment. Which adjustment best fits the discordance between his respiratory rate and lung examination?
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Correct answer: C - Reduce albuterol intensity and reassess for beta-agonist-associated lactic acidosis.
Question 8
While treatment begins for a 6-year-old's asthma exacerbation, the team records these pretreatment findings: room-air SpO2 91%, suprasternal retractions, no scalene muscle contraction, minimal bilateral air entry, and no audible wheeze even with a stethoscope. What Pediatric Respiratory Assessment Measure (PRAM) score and severity correspond to this examination?
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Correct answer: C - 10 points - severe exacerbation
Domain 13: Gastrointestinal 3% of exam
Question 9
An 8-month-old has repeated episodes of sudden pallor and limpness lasting two to three minutes, followed by a return to normal interaction. During one observed episode he first cries intensely, then becomes unusually quiet. He has vomited once, without bile, and has passed no blood in the stool. Between episodes his abdomen is soft without a palpable mass and his neurologic examination is normal. Bedside glucose is 86 mg/dL. Which investigation has the highest priority?
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Correct answer: D - Abdominal ultrasonography
Domain 20: Endocrine 2% of exam
Question 10
A 12-year-old with newly diagnosed diabetic ketoacidosis has received isotonic fluids for 90 minutes but no insulin. He is alert, his perfusion has improved, and urine output is documented. Repeat laboratory values are glucose 420 mg/dL, venous pH 7.12, bicarbonate 8 mmol/L, and potassium 2.6 mmol/L. Which treatment sequence is appropriate at this point?
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Correct answer: A - Replace potassium under cardiac monitoring before starting the insulin infusion.